Experimental study on the diagnosis of dry eye tear film grading by Keratograph 5M ocular surface analyzer and conventional ocular surface examination / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the diagnostic value of Keratograph 5M for the diagnosis of dry eye(dry eye)tear film grading. <p>METHODS: Totally 100 eyes diagnosed with dry eye by conventional means and 40 non-dry eye eyes with suspected dry eye at the same time were enrolled through OPC. The immediate ocular surface parameters of the above cases were collected by the K5M ocular surface analyzer, including the first tear film rupture time(NIBUTf), the average tear film rupture time(NIBUTav), and the tear river height(TMH)which were utilized to evaluated the diagnostic efficacy of K5M compared to routine ocular surface examination on the index of dry eye tear film. <p>RESULTS: The comparison of NIBUTf, NIBUTav and TMH between dry eye group and non-dry eye group by K5M eye surface comprehensive analyzer showed statistically significant differences(all <i>P</i><0.05). The coincidence rate between the NIBUTf of K5M ocular surface analyzer and the BUT of routine diagnosis was 78.6%, and the area under the ROC curve as well as the standard error were 0.042 and 0.795(<i>P</i><0.01)with 95% confidence interval(0.712, 0.878); The coincidence rate between NIBUTav of K5M and BUT of routine examination diagnosis was 73.6%, and the area under the ROC curve as well as the standard error were 0.853 and 0.033(<i>P</i><0.01), with 95% confidence interval(0.788, 0.917).The coincidence rate between TMH of K5M and the SⅠt of conventional diagnosis was 87.9%, and the area under the ROC curve as well as the standard error were 0.795 and 0.044(<i>P</i><0.01), with the 95% confidence interval(0.709, 0.880). The sensitivity, specificity, correctness index, positive likelihood ratio, negative likelihood ratio, and odds ratio of the exploratory diagnosis of dry eye by NIBUTf combined with TMH were 98, 40, 38, 1.63, 0.05, and 32.6%, respectively. The sensitivity, specificity, correctness index, positive likelihood ratio, negative likelihood ratio, and odds ratio of the exploratory diagnosis of dry eye by NIBUTav combined with TMH were 86, 75, 61, 3.44, 0.187, 18.39%, respectively.<p>CONCLUSION: K5M ocular surface analyzer can provide accurate and reliable diagnostic value for single tear film index grading diagnosis of dry eye; compared with TMH combined with NIBUTav, TMH combined with NIBUTf was more sensitive but less specific in diagnosing dry eye.

The clinical profile and prevalence of dry eye in tertiary care hospital- based population

Background: Dry eye is recognized as a growing public health problem and one of the most frequent reasons for visiting an ophthalmologist in middle and old age people. Objectives: To the best of our knowledge, very less study has been undertaken in central India on dry eye. The present study was designed to study clinical profile and to evaluate the true prevalence and risk factors of dry eye in central India. Materials and Methods: A total of 1562 participants aged 30 years or more visiting ophthalmology department in a tertiary care rural hospital enrolled in a study. Study duration was 18 months. The study design was a prospective, cross-sectional, and observational study. An ocular surface disease index (OSDI) questionnaire was administered to all participants and individuals with OSDI score greater than 12 were further evaluated with dry eye tests in sequence of tear break-up time, lissamine green staining, Schirmer-1 test, and slit-lamp examination for meibomian gland dysfunction. The participants with OSDI Score ≥13 were diagnosed to be having dry eye. The data were compiled and subjected to statistical analysis using SPSS v.17.0 software (SPSS Inc., Chicago, Illinois, USA). P < 0.05 was considered to be statistically significant. Results: Prevalence of dry eye in our study was 24.7%. Prevalence of lipid layer, aqueous layer, and mucin layer deficiency dry eye was 13.8%, 5.2%, and 7.8%, respectively. Increasing age, illiteracy, and menopause were the significant risk factors and female sex, urban habitat, and laborer and factory worker were insignificant risk factors for dry eye. Conclusion: Prevalence of dry eye in our study is higher than reported in literature in central India. Lipid anomaly dry eye was the most prevalent, followed by mucin layer deficiency and lastly aqueous tear deficiency.

A Study on Evaluation of Ocular Surface Disease in Patients with Glaucoma

Background: Ocular surface disease is the most common, underdiagnosed comorbidity of glaucoma. Ocular surface diseaseaffects the quality of life of glaucoma patients apart from causing visual disturbances. Evaluation of ocular surface disease isimportant for complete management of glaucoma.Aims and Objectives: This study aims to evaluate the subjective and objective measures of ocular surface disease in patientswith glaucoma.Materials and Methods: A cross-sectional study was carried out on 108 eyes of 54 glaucoma patients on topical antiglaucomamedications for >6 months at the department of ophthalmology from January 2018 to January 2019. Subjective evaluation withocular surface disease index (OSDI) score and objective evaluation with tear breakup time (TBUT) and Schirmer test werecarried in all patients.Results: The subjective measure with OSDI score >12 was observed in 55.6% of glaucoma patients. The objective measures withTBUT <10 s and Schirmer test <10 mm in 5 min were observed, respectively, in 64.8% and 53.7% of glaucoma patients. Patientson longer duration (>15 months) of topical antiglaucoma medications and patients on multiple topical antiglaucoma drugs had higherOSDI score, lesser TBUT, and lesser Schirmer test values. OSDI score had strong positive correlation with TBUT and Schirmer test.Conclusion: Prompt evaluation of ocular surface disease, use of fixed-drug combinations, use of preservative-free antiglaucomaeye drops, and supplementation with lubricants will improve the compliance of patients and outcome of glaucoma management.

Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis / 가정의학회지

BACKGROUND: The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease. METHODS: We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias. RESULTS: Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010). CONCLUSION: The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.

The Influence of Preoperative Meibomian Gland Disease on Dryness after Cataract Surgery

PURPOSE: The aim of this study is to analyze the influence of preoperative meibomian gland disease (MGD) on the postoperative dry eye disease after cataract surgery. METHODS: 100 eyes of 85 patients who had undergone cataract surgery were enrolled. Patients were stratified into three groups by the severity of meibomian gland disease (MGD Grade I, MGD Grade II and MGD Grade III). In each group, we recorded the indexes of dry eye such as Ocular surface disease index, tear breakup time, Schirmer's test and Corneal staining at preoperatively and postoperative week 1, 2, 5, 9. We compared the indexes, preoperatively and postoperatively between three groups. RESULTS: In comparison of the preoperative indexes between groups, the more severe meibomian gland disease the patients have, the higher Ocular surface disease index and the shorter tear breakup time were observed (p < 0.05). In comparison the preoperative with the postoperative indexes, Ocular surface disease index was higher and tear breakup time was shorter at every postoperative moment in MGD Grade (Gr) II and Gr III. In comparison between MGD groups, MGD Gr III showed higher ocular surface disease index than MGD Gr I and Gr II at every follow up point, and shorter tear breakup time than MGD Gr I and Gr II at preoperative and postoperative week 1 and 9 (p < 0.05). CONCLUSIONS: The severity of meibomian gland disease which exist preoperatively can affect the aggravation of dry eye disease after cataract surgery. Therefore, the treatment of meibomian gland disease before cataract surgery can be a therapeutic option to prevent aggravation of dry eye after cataract surgery.

Dry eye after clear cornea phacoemulsification

Objective@#To determine the incidence of dry eye in patients undergoing clear cornea phacoemulsification and to investigate its effects on dry eye symptoms and tear function. @*Methods@#This was a single-center, prospective, non-randomized study involving forty-nine (49) eyes from fortyfour (44) patients without preoperative dry eye, who underwent clear cornea phacoemulsification for age-related cataract. Main outcome measures were subjective grading of ocular discomfort, ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), and Schirmer tests without anesthesia and with anesthesia. They were measured before surgery and 1 week, 1 month, and 3 months after surgery. @*Results@#None of the patients qualified for the definition of dry eye disease before and after clear cornea phacoemulsification. Preoperative FTBUT (14.01 ± 0.56 seconds) decreased at 1 week (3.97 ± 0.21 seconds; p<0.001) and at 1 month (5.82 ± 0.32 seconds; p<0.001) after the surgery and gradually improved by 3 months (8.26 ± 0.54 seconds; p<0.001) after surgery. Preoperative Schirmer test without anesthesia (18.78 ± 1.17 mm) decreased at 1 week (14.02 ± 1.52 mm; p<0.001) and subsequently recovered by 3 months (16.31 ± 1.34 mm; p>0.05). Preoperative Schirmer test with anesthesia (14.24 ± 0.94 mm) decreased at 1 week (11.98 ± 1.00 mm; p=0.046) after surgery and went back to baseline levels by 3 months (13.80 ± 1.12 mm; p>0.05). @*Conclusion@#Patients without dry eye disease, who underwent clear cornea phacoemulsification, did not develop dry eye disease after the surgery. Temporary reduction in physiologic tear levels seen one week postsurgery gradually returned to near-normal baseline levels by the third postoperative month.

The Changes in Tear Film and Corneal Sensation after Refractive LASIK Surgery for Presbyopia

PURPOSE: To evaluate the changes in break-up time (BUT) and corneal sensitivity following LASIK surgery for refractive error correction with presbyopia in patients older than 45 years. METHODS: The authors of the present study measured the BUT and corneal sensitivity of 92 eyes that received LASIK surgery for correcting refractive error with presbyopia. The eyes were divided into groups according to gender and preoperative refractive error before surgery and 1, 3, 6 and 12 months after LASIK. RESULTS: The mean age of patients was 52.01 +/- 5.51 years, and the male to female eye distribution was 31:61. The value of BUT before surgery and 1, 3, 6, and 12 months postoperative was 5.31 +/- 2.03 sec, 4.47 +/- 1.67 sec, 4.04 +/- 1.58 sec, 4.53 +/- 1.51 sec, and 4.87 +/- 1.46 sec, respectively; corneal sensitivity was 56.35 +/- 5.94 mm, 40.07 +/- 14.21 mm, 46.42 +/- 10.41 mm, 50.75 +/- 8.04 mm, and 52.92 +/- 7.51 mm, respectively. BUT was not significantly different relative to refractive error and was significantly shorter in the female group than the male group at 1 month postoperative. Corneal sensation of myopia at 12 months postoperative was statistically higher than at other time points; however, there was no difference between genders. BUT and corneal sensitivity at 12 months postoperative recovered to 91.6% and 93.9% of the preoperative value, respectively. CONCLUSIONS: BUT and corneal sensitivity after LASIK for presbyopia were decreased until 12 months postoperative and recovered slowly, but did not return to preoperative levels.

Results of preservative free sodium hyaluronate and basic fibroblast growth factor eye drops in the treatment of dry eyes after ophthalmic surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the results of preservative free sodium hyaluronate and basic fibroblast growth factor(bFGF) eye drops in the treatment of dry eyes after eye operation.·METHODS: One hundred and thirty two patients of dryeyes underwent 149 different eye surgeries. The Schirmer test Ⅰ and tear break up time (BUT) were performed prior to surgery and post operatively after 2 weeks and after 4 weeks when the patients were using Oflaxacine, Tobramycin-dexamethasone eye drops. In addition, preservative free sodium hyaluronate and bFGF eye drops were given post operatively. The antibiotic-cortisone eye drops were stopped after the requirted period depending on the type of eye surgery done, and preservative free sodium hyaluronate and bFGF eye drops were stopped after 4 weeks.Then, after 5 weeks Schirmer test Ⅰ and BUT were done.·RESULTS: The Schirmer test Ⅰ and BUT results prior to surgery and after eye surgery showed a statistically significant improvement of the dry eye condition.·CONCLUSION: Usage of preservative free sodium hysluronate and bFGF eye drops help definitely in the management of dry eye after ophthalmic surgery.